[The comparison of preemptive analgesic efficacy between short-acting ketamine and long-acting parecoxib]

Objective: To compare the analgesic efficacy between preoperative single-dose ketamine, a short-acting medicine and parecoxib, a long-acting medicine for reducing analgesic consumption in the first 24 h after-operation. Methods: Eighty-one patients from Beijing Chaoyang Hospital undergoing laparoscopic uterus surgery between April and December 2015 were randomly divided into three groups: control group (group C), ketamine group (group K) and parecoxib sodium group (group P). All patients were anesthetized with general anesthesia and received sufentanil-based patient-controlled intravenous analgesia (PCIA). After induction and 10 min before incision, patients in group K, P and C were injected with intravenous 0.5 mg/kg ketamine, 40 mg parecoxib and 2 ml normal saline, respectively. The primary outcome was sufentanil consumption within 1 h and 24 h after surgery. Other outcomes included the visual analog scale (VAS) pain score at 0, 15, 30, 45min and 1, 2, 4, 8, 24 h after surgery, PCIA effective trigger times, and adverse reactions. Results: The postoperative sufentanil consumptions within 1 h in group K and P were(4.420±1.836)μg and (2.878±1.984)μg, respectively, and consumptions within 24 h were(28.200±3.712)μg and (25.511±4.037)μg, respectively, which were significantly less than that in group C with (6.144±2.346)μg within 1 h and (31.505±7.042)μg within 24 h (F=15.360, 8.406, all P<0.05). Patients in group P needed less sufentanil than group K in 1 h after surgery (P<0.05), however, the difference was not statistically significant in 24 h(P>0.05). The PCIA trigger times were 2(3.75) in group C, 0(1.50) in group K, and 0(1.00) in group P. Group K and P had less PCIA trigger times compared to group C (all P<0.05). Compared to group C, group K and P had lower VAS scores at 0, 15, 30 min after surgery and group P had lower VAS scores at 1, 15, 30, 45 min, 2 h after surgery, respectively (all P<0.05). There were no differences between groups in the incidence of any adverse effects(all P>0.05). Conclusion: A single injection of short-acting ketamine before laparoscopic uterus surgery, has the same efficacy as long-acting parecoxib for opioid-sparing effect in the first 24 h after-operation. However, parecoxib has better analgesic effect in the early postoperative period.